Abstract: Objective To evaluate the related efficiency indicators of tirofiban dosing regimens in elderly patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) using the data envelopment analysis (DEA) model, and to provide evidence for treatment optimization. Methods A total of 278 elderly AMI patients who received emergency PCI were prospectively enrolled from the Department of Cardiology, Guangzhou Red Cross Hospital between September 2023 and December 2024. They were assigned to the low-dose group (n = 93), the standard-dose group (n = 92) and the high-dose group (n = 93) using the random number table method. The low-dose group received a tirofiban loading dose of 5 μg·kg^-1 followed by a maintenance dose of 0.075 μg·kg^-1·min^-1; the standard-dose group received a loading dose of 10 μg·kg^-1 followed by a maintenance dose of 0.15 μg·kg^-1·min^-1; the high-dose group received a loading dose of 15 μg·kg^-1 followed by a maintenance dose of 0.225 μg·kg^-1·min^-1. All patients received continuous intravenous pump infusion for 24 hours. Postoperative myocardial enzymes, thrombolysis in myocardial infarction (TIMI) grade 3 flow rate, proportion of ST-segment resolution ≥ 50%, incidence of intraoperative no-reflow or slow flow, incidence of major adverse cardiovascular events (MACE), average drug cost per patient, total hospitalization cost, length of hospital stay and coronary care unit (CCU) stay duration were compared across the three groups. The DEA model was used to comprehensively evaluate the comprehensive efficiency (θ), pure technical efficiency (PTE) and scale efficiency (SE) of the three regimens, with average drug cost per patient, total hospitalization cost and MACE incidence as input indicators, and TIMI grade 3 flow rate, proportion of ST-segment resolution ≥ 50%, reduction in length of hospital stay and reduction in CCU stay duration as output indicators. Results There were no statistically significant differences among the three groups in postoperative peak myocardial enzymes, including creatine kinase isoenzyme MB (CK-MB) and cardiac troponin T (cTnT), as well as TIMI grade 3 flow rate, proportion of ST-segment resolution ≥ 50% and incidence of intraoperative no-reflow or slow flow (P > 0.05). No statistically significant difference was observed in the overall incidence of MACE among the three groups (P > 0.05). The standard-dose group was significantly superior to the other two groups in average drug cost per patient, total hospitalization cost, length of hospital stay and CCU stay duration (P<0.05). DEA evaluation showed that the θ value of the standard-dose group was significantly higher than that of the low-dose and high-dose groups (P<0.001). Conclusion The standard-dose tirofiban regimen can ensure clinical efficacy while significantly reducing medical costs and shortening hospital stay, with the highest θ value. It achieves the optimal balance of efficacy, safety and cost-effectiveness, and is the preferred treatment regimen for elderly AMI patients undergoing PCI.